Neutrophil Migratory Patterns: Implications for Cardiovascular Disease.

The body's inflammatory response involves a series of processes that are necessary for the immune system to mitigate threats from invading pathogens. Leukocyte migration is a crucial process in both homeostatic and inflammatory states. The mechanisms involved in immune cell recruitment to the site of inflammation are numerous and require several cascades and cues of activation. Immune cells have multiple origins and can be recruited from primary and secondary lymphoid, as well as reservoir organs within the body to generate an immune response to certain stimuli. However, no matter the origin, an important aspect of any inflammatory response is the web of networks that facilitates immune cell trafficking. The vasculature is an important organ for this trafficking, especially during an inflammatory response, mainly because it allows cells to migrate towards the source of insult/injury and serves as a reservoir for leukocytes and granulocytes under steady state conditions. One of the most active and vital leukocytes in the immune system's arsenal are neutrophils. Neutrophils exist under two forms in the vasculature: a marginated pool that is attached to the vessel walls, and a demarginated pool that freely circulates within the blood stream. In this review, we seek to present the current consensus on the mechanisms involved in leukocyte margination and demargination, with a focus on the role of neutrophil migration patterns during physio-pathological conditions, in particular diabetes and cardiovascular disease.

Evidence based management of intracapsular neck of femur fractures.

Neck of femur fractures are occurring at an increased incidence. Functionally independent patients without cognitive impairment can expect reasonable life expectancy. This indicates the need for a durable surgical option that optimises the chance to return to pre-injury functional status, with minimal risk of complications and reoperation. Most fractures are displaced. Surgical options include internal fixation, hemiarthroplasty or total hip arthroplasty (THA). Evidence is conclusive that arthroplasty options outperform internal fixation in terms of function, quality of life and reoperation rates. In anyone other than young patients where head preserving surgery is required, arthroplasty is the standard of care. Hemiarthroplasty is the heavily favoured arthroplasty option for surgeons. However, in patients other than the extreme elderly, medically infirm, neurologically impaired, or with little or no ambulatory capacity, the evidence to support hemiarthroplasty is lacking. In functionally independent patients without cognitive impairment, THA should be considered the gold standard, producing better functional and quality of life outcomes, lower reoperation rates and better cost effectiveness, with no difference in complications or mortality. An increased risk of dislocation does exist. This may be reduced with modern surgical technique and implant options. Low amounts of research have been afforded to undisplaced fractures. For this fracture type, surgery is the standard of care. Despite a higher risk of reoperation, internal fixation is the preferred option for all age groups. Further study is required to identify the difference between internal fixation and THA, in particular, for unstable fracture patterns in elderly patients.

Outcomes of a shoulder treatment flowchart in patients with axillary burns.

The purpose of this study was to evaluate the effects of a structured shoulder treatment flowchart on range of motion (ROM) and function of the upper limb in patients at high and low risk of contracture after an axillary burn injury. Consecutive patients with axillary burns were managed according to a structured pathway based on risk of contracture. Those patients with deep partial- or full-thickness burns to more than one area of the axilla or requiring more than one split skin graft were classified as high risk; these patients underwent a more aggressive approach to splinting and exercise. Measurements of shoulder ROM and functional ability (upper extremity functional index) were made at admission, hospital discharge, and at 12 weeks postdischarge. Twenty patients (19 men) with an average age of 39 years and a median TBSA of 20% were recruited. Median length of stay was 18 days. Ten patients were classified as high risk. Both low-risk and high-risk patients showed good range of movement outcomes at discharge and 12 weeks, with no significant differences between risk groups (abduction at 12 weeks, mean [SD]: 168° [22°] vs 166° [28°], P = .60; flexion at 12 weeks, mean [SD]: 172° [20°] vs 167° [31°], P = .60, respectively). There were no differences in functional outcomes at 12 weeks postdischarge. Use of a shoulder treatment pathway was associated with good shoulder ROM and functional capacity in patients at high and low risk of axillary contracture.